Congress Abstracts 2005

43

COMBINED MODALITY THERAPY FOR LOCALLY ADVANCED ESOPHAGEAL CANCER: THE NURSES ROLE IN MANAGING SIDE EFFECTS. Ethel Beeling Law, RN, MA, OCN^®, E. Linda Frierson, RN, BSN, and Stephen Gavin, RN, BSN, Memorial Sloan-Kettering Cancer Center, New York, NY.

Esophageal cancer is an aggressive tumor. Five-year survival with locally advanced disease is 25%; surgery or radiation alone has failed to improve survival. Preoperative chemoradiotherapy followed by resection results in an improved 5-year survival of 35%. However, concurrent chemoradiation is associated with greater grade 3 gastrointestinal and mucosal toxicity than with radiotherapy alone (44% vs 25%) which may lead to severe dehydration and hospitalization. These side effects can lead to pain and nutritional deficits that affect quality of life and to breaks in treatment which may impact on the effectiveness of therapy.

Medical and radiation oncology nurses play a key role in managing the side effects of chemoradiation. This presentation will provide a comprehensive review of the newer concurrent therapies, describe potential toxicities, and discuss interventions to prevent and manage symptoms.

The medical and radiation oncology nurses collaborate to coordinate the start of treatment and timing of MediPort placement for continuous chemotherapy. They provide a calendar of the treatment regimen to ensure understanding and compliance. Education includes preparation for simulation, discussion of possible side effects of chemoradiation, and review of self-care measures to minimize these. Chemotherapy used in combination with radiotherapy includes fluorouracil, cisplatin, mitomycin, irinotecan, and paclitaxel; drug-specific side effects are also reviewed. Side effects are assessed throughout treatment. Prophylactic anti-emetics are given to encourage food and fluid intake. Pain from odynophagia or stomatitis is managed aggressively. About 50% of patients receiving paclitaxel and cisplatin suffer from grade 2+ electrolyte imbalances, which require IV hydration with electrolyte replacement. Five percent of patients require an enteral feeding tube to supplement oral intake. Colony stimulating factor may be initiated for myelosuppression to reduce the risk of infection.

Nurses play a pivotal role in managing patients on multimodal therapy for locally advanced esophageal cancer and can have a great impact in helping them tolerate their treatment with optimal quality of life, minimal treatment breaks, and less hospitalizations.

Comprehensive knowledge of the various treatments and potential toxicities provides a foundation for nursing assessment, identification of patients at risk for complications, early recognition of side effects, and intervention to improve tolerance of treatment.